100 Free MCCQE1 Questions (all accurately answered)
Question : An 80-year-old woman comes to the urgent care
clinic with dyspnoea on exertion. On physical examination, her blood pressure is 100/70, and her pulse is 75. She has no pulsus paradoxus. Her jugular veins are distended, and she has distant heart sounds. In addition, she has extra third and fourth heart sounds. Her liver is enlarged, and she has pedal oedema. She has occasional premature ventricular contractions on her electrocardiogram. A chest x-ray reveals clear lung fields with a dilated cardiac silhouette. Her echocardiogram reveals ventricular walls with a "speckled pattern". Which of the following is the most likely diagnosis?
Alcoholic cardiomyopathy
Amyloidosis
Haemochromatosis
Tuberculosis
Viral myocarditis
Correct answer: Amyloidosis
Restrictive cardiomyopathy with 'speckled' left ventricular wall Primary cardiac amyloidosis usually develops into diastolic dysfunction
Alcoholic cardiomyopathy: biventricular dilated
cardiomyopathy
Question : A 92-year-old man with a 45-year history of
chronic obstructive pulmonary disease is intubated in the ICU because of a bout of viral pneumonia that fails to improve after 72 hours of antibiotics. Although the inspired fraction of oxygen is 100%, the patient's pO2 remains at 57 mmHg.Positive-end expiratory pressure (PEEP) is added to allow the inspired fraction of oxygen. Twelve hours after the introduction of PEEP the patient suddenly become hypotensive. At the same time, his oxygen saturation drops from 92% to 61%. On physical examination, his BP is 80/50 mmHg and his pulse is 124/min. He has distended neck veins
and distant heart sounds. Which of the following would also most likely be seen on this patient's physical examination?
Absence of breath sounds in the right hemithorax
High amplitude carotid artery upstroke
A pleural friction rub
Pulsus alternans
Splenomegaly
Correct answer: Absence of breath sounds in the right
hemithorax Patient has developed a tension pneumothorax, characterised by PEEP followed by sudden hypotension and decreased oxygenation Jugular venous distention occurs because venous return to the right side of the heart is being compressed
Rx: immediate needle/tube thoracostomy
Question : A 46-year-old man with a history of hypertension
and hypercholesterolemia visits the physician for a routine followup. The patient's job involves a lot of travelling, and he admits to occasionally forgetting to take his medications with him when he travels. He complains of several episodes of chest pain in the past few months. The pain is sharp in nature, mainly over his lower chest and epigastrium, and tends to come on when walking. He believes these episodes are due to indigestion and has been taking antacids. There is a family history of heart disease, and his father died of a heart attack at age 48. On physical examination, his blood pressure is 150/80 mmHg and heart rate is 86/min. His lungs are clear to auscultation. Cardiac auscultation reveals normal rate and rhythm, without rubs, gallops, or murmurs. There is no pedal oedema. He is sent for an exercise stress test. Five minutes into the test, he develops ST
Correct answer: Coronary angiography
Multiple risk factors for atherosclerotic coronary artery disease A stress test is considered positive when there are ST depression of >1mm for longer than 0.08 seconds Positive stress test = coronary angiography